HAR §17-1724.1-62. Purpose

This subchapter describes the methodology used to determine the cost share of a MAGI-excepted individual requesting coverage of long-term care services. [Eff 09/30/13, am and comp tmv 1 O 2015 J (Au th: HRS §346-14; 42 C.F.R. §§435.733, 435.735, 435.831, 435.832) (Imp: HRS §346-14; 42 C.F.R. §§435.733, 435.735, 435.831, 435.832) §17-1724.1-63 Post-eligibility treatment of income fqr a MAGI-excepted individual meeting institutional level of care and receiving long-term care services. (a) A MAGI-excepted individual meeting institutional level of care and determined eligible to receive long-term care services shall have countable income applied toward the cost share of long-term care and other medical care costs when the individual is: (1) Residing in a nursing facility or a medical facility; or (2) Medically needy and residing in the community receiving home and community based services {under 42 C.F.R. §435.217). (b) The cost share for an individual described in subsection (a) is determined by deducting the following from the individual's countable income: 3 2-0 6 114 (1) A personal needs allowance of: {A) $50 for an individual residing in a nursing facility or medical facility; 1724.1-38 §17-1724.1-63 (B) One hundred percent of the FPL for a household of one for an individual residing in their home in the community; or (C) The medically needy standard of assistance for a household of one for an individual residing in a community care foster family home or extended adult residential care home. (2) Amounts for the maintenance needs of the community spouse and dependent family member(s) of the individual meeting institutionalized level of care and receiving long term care services shall be deducted from the individual's income as follows: (A) The contribution from the individual to the community spouse shall not exceed the difference between the maximum monthly maintenance needs allowance and the gross monthly income of the community spouse. The maximum maintenance needs allowance for the community spouse is defined by federal statutes or regulations and is subject to increases by means of indexing or court order; (B) The dependent allowance for each dependent family member residing with the community spouse, shall be equal to one third the amount of the spousal allowance in subparagraph (A) which exceeds the gross monthly income of that family member; or (C) The family allowance for any or all dependent family members residing in the home of the institutionalized individual without the community spouse, shall be equal to ~he medically needy standard of assistance for a household of equal size minus the total 1724.1-39 3206 )20 6 §17-1724.1-63 monthly gross income of all dependent family members. (3) Any incurred medical expenses deducted from excess income pursuant to chapter 17-1730.1, that are not covered by the medical assistance program, excluding any unpaid portion of long-term care costs that were not payable by medical assistance during a penalty period for the transfer of assets for less than fair market value that was established under the provisions of chapter 1725.1. (c) Any income remaining, which shall be rounded down to the whole dollar following the procedures of subsection (b) , represents the amount of the individual's cost share. [Eff 09/30/13; am and comp NOV 10 2016 ] (Auth: HRS §346-14; 42 C.F.R. §§435.217, 435.726, 435.733, 435.735, 435.831, 435.832; 42 U.S.C. §§1315, 1396a(r), 1396r-5) (Imp: 42 C.F.R. §§435.217, 435.726, 435.733, 435.735, 435.831, 435.832; 42 U.S.C. §§1315, 1396a(r), 1396r-5) §